Objective To investigate the correlation of neutrophil to high-density lipoprotein cho-lesterol ratio(NHR)and lipoprotein(a)[Lp(a)]with occurrence of acute ischemic stroke(AIS)in elderly patients with non-valvular atrial fibrillation(NVAF).Methods A total of 301 elderly NVAF patients admitted to Hefei First People's Hospital from May 2020 to May 2023 were en-rolled,and according to whether they were combined with AIS or not,they were divided into stroke group(143 cases)and non-stroke group(158 cases).Binary logistic regression analysis was used to screen risk factors,and ROC curve was plotted to assess their predictive values for AIS.Results Lp(a)and NHR in stroke group were significantly higher than those in non-stroke group,the difference was statistically significant(P＜0.01).Multivariate binary logistic regression analysis showed that NHR and Lp(a)were independent risk factors for death with NVAF com-bined AIS(OR=1.728,95％CI:1.367-2.186,P=0.000;OR=1.005,95％CI:1.002-1.007,P=0.000);ROC curve analysis indicated that the AUC value of NHR and Lp(a)in diagnosing AIS in NVAF patients was 0.668 and 0.735,respectively,and that of their combination was 0.789,which was significantly higher than that of NHR and Lp(a)alone(P＜0.01).Conclusion NHR and Lp(a)are independently related to AIS in NVAF patients,and their combination has certain diagnos-tic efficacy.

Human challenge trial (HCT) is a test in which human volunteers are intentionally infected with pathogens in order to evaluate the efficacy of candidate preventive or therapeutic drugs. During the COVID-19 pandemic, the HCT of vaccines has aroused people's attention due to its significant advantages over clinical trial. This paper introduces the concept, development and application of HCT, the advantages and limitations of HCT for vaccine evaluation, and the consideration of future HCT of COVID-19 vaccine in China.

Objective:To investigate the incidence and determinants of vaccine hesitancy towards national immunization program in China and understand the current status of parents' hesitancy to different vaccines used in national immunization program.Methods:A cross-sectional survey was conducted in Beijing, Sichuan and Gansu. The methods of proportional probability sampling and convenience sampling were used to select the eligible study subjects for questionnaire surveys.Results:A total of 3 592 parents were enrolled in the study, in whom 38.22% fully accepted all the vaccines, 59.35% agreed to let their children to receive all the vaccines but showed slight concern, and 2.42% had hesitancy to the vaccines. The vaccine with the most hesitancy was polio vaccine (0.89%), followed by diphtheria pertussis tetanus vaccine (0.70%) and hepatitis A vaccine (0.64%). The dominant reason for vaccine hesitancy was the risk-benefit perception of vaccination (31.03%), followed by the low awareness of the parents (21.84%) and the inconvenience caused by distance and time (21.84%).Conclusions:The incidence of vaccine hesitancy towards national immunization program was low in parents in China, but over 50% of the parents showed concern to the vaccines. It is essential to improve the service quality of national immunization program and strengthen the health education about the vaccination to reduce the incidence of vaccine hesitancy in parents.

Objective:This study intended to explore the current sexual and childbearing stigma, experienced by chronic hepatitis B patients in China, and to develop related preventive strategies.Methods:We used a self-made questionnaire to investigate the sexual and childbearing stigma suffered by chronic hepatitis B patients in four provinces of China. Analysis of variance and chi-square test were used to compare the differences on sexual and childbearing stigma indexes between different demographic variables.Results:We surveyed 797 chronic hepatitis B patients in four provinces. Among them, 4.15 % (28/675) of the patients were persuaded not to give birth to children, and 4.67 % (10/210) of patients were told to stop pregnancy, by their medical care takers or by members from the family planning institutions. 3.62 % (25/690) and 3.48 % (24/690) of the patients were not able to enjoy the family planning or reproductive health services as they were stigmatized,suffered, as having HBV infection. Among the male chronic hepatitis B patients, the under 30 years group suffered less sexual and childbearing stigma than those who were aged 31- ( P=0.011) or 51 and above year-olds ( P=0.009). Among female chronic hepatitis B patients, the 31- year-olds group suffered less sexual and childbearing stigma than those under 30 years group but higher than those aged 41- ( P=0.001) or 51 and above ones ( P<0.001). Patients with knowledge on route of sexual transmission for HBV, were more likely to practice less related sexual behaviors than those without such knowledge ( P=0.022). Patients who were aware or not that condoms could reduce the risk of HBV infection did not show statistically significant difference on sex behaviors ( P=0.612). Conclusions:Chronic hepatitis B patients did suffer from sexual and childbearing related stigma, with women aged 31-40 years old the most. It is necessary to advocate on the advantage of condom use for prevention of HBV transmission among pregnant women, both horizontally and vertically. Strategies on protection the rights of patients with hepatitis B should be developed and strengthened.

Objective: To analyze the correlation between the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) sacroiliac joint inflammation score (SPARCC score)/structural score (SSS) and the disease activity as well as the functional indexs. The correlation between the MRI score and inflammatory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] in patients with active axial spondyloarthritis (axSpA) before and after treatment was explored. In addition, the contribution of the two MRI scoring method in evaluating conditions was also explored. Methods: According to the inclusion criteria, 24 patients with active axial SpA were recruited and received the recombinant hauman tumor necrosis factor (TNF)-α receptor Ⅱ: IgG Fc fusion protein(rhTNFR:Fc), sulfasalazine and thalidomide for 12 weeks. Subjects were scored at week 0 and 12 by SPARCC/SSS scores. Bath ankylosing spondylitis disease activity index (BASDAI), Assessment of Spondyloarthritis Intemational Society (ASAS)-endorsed disease activity score(ASDAS)-CRP, bath ankylosing spondylitis functional index (BASFI). Bath ankylosing spondylitis metrology index(BASMI), ESR and CRP. The correlation between the SPARCC/SSS scores and that of clinical indicators were analyzed. Paired sample t test, Wilcoxon signedrank test, Spearman correlation analysis and Pearson correlation analysis were used for statistical analysis, and receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of SPARCC score decline as a response to treatment. Results: ① Compared with baseline, after 12 weeks treatment, SPARCC scores [(15±4) and(33±10)], BASDAI [(3.2±0.9) and (5.2±1.1)], BASFI [(2.3±0.6) and (4.6±1.0)], BASMI [(2.3±0.7) and (4.1±1.1)], ASDAS-CRP scores [(2.0±0.8) and (3.7±0.9)], ESR [(16±12) mm/1 h and (49±26) mm/1 h], CRP [(7.2±2.8) mg/L and (30.4±19.3) mg/L] were significantly decreased (t values were 7.822, 6.950, 10.707, 7.204, 6.281,-4.015 and-4.257, respectively), and the differences were statistically significant (P=0.000). There was no significant difference in SSS scores between baseline [(20±6) and (19±7)] and after 12 weeks treatment (t=-0.761, P=0.455). ② Before treatment, SPARCC score showed positive linear correlation with BASDAI (r=0.630, P=0.001), ASDAS-CRP (r=0.646, P=0.001), CRP (r=0.574, P=0.003) and ESR (r=0.559, P=0.004), and the correlation of the above indexes disappeared after treatment (P>0.05). The association between SPARCC structral scores and the above indicators was not significant before and after treatment. ③ Areas under curve(AUC) of ROC for assessing treatment response by reduced SPARCC scores was 0.809. The cut-off value for response to treatment was 20.5, with the sensitivity of 68.8% and specificity of 75.0%. Conclusion The SPARCC MRI SIJ inflamm-ation score has certain value in evaluating disease activity and efficacy, while the SPARCC SSS is not.

Objective To observe the clinical efficacy and safety of Biyuan Tongqiao granule combined with triamcinolone acetonide spray in the treatment of patients with chronic rhinosinusitis .Methods A total of 106 patients with chronic rhinosinusitis in the Traditional Chinese Medicine Hospital of Anji County from February 2015 to February 2017 were selected as study objects .According to different treatment plan , the patients were randomly divided into the control group and the combined group , with 53 cases in each group .The control group received triamcinolone acetonide nasal spray 220μg, 1 time/d, one week later , the dosage adjusted to 110μg, 1 time/d.The combined group was given Biyuan Tongqiao granules 15 g,three times /d on the basis of the treatment of the control group.The clinical efficacy,SONT -20,VAS score,paranasal sinus CT score and incidence rate of adverse reaction were analyzed before and after treatment in the two groups .Results The total effective rate of the combined group was 94.34％,which was higher than 81.13％ of the control group,the difference was statistically significant (χ2 =4.296,P=0.038).The SNOT-20,VAS and Lund-Mackey sinus CT score in the combined group were better than those in the control group,the differences were statistically significant (t=7.661,9.189,7.183, 9.269,10.470,all P<0.05).The incidence rate of adverse reactions in the two groups was 7.55％,the difference was not statistically significant (χ2 =0.000,P =1.000).Conclusion Biyuan Tongqiao granule combined with triamcinolone acetonide spray in the treatment of patients with chronic rhinosinusitis can improve the clinical efficacy and reduce pain of patients ,it is worthy of popularization and promotion in clinical .

Objective To research the efficacy and safety of sequential rivaroxaban use in reducing blood loss after applying tranexamic acid(TXA)in total hip arthroplasty(THA).Methods According to the design by the random control principle,150 pa tients undergoing unilateral primary THA from September 2012 to June 2015 were selected and randomly divided into the group A,B,C,D and E (n=30).The group A did not use TXA,the group B received intravenous drip of 10 mg/kg TXA at 10 min before skin incision,the group Creceived intravenous drip of 15 mg/kg TXA at 10 min before skin incision,the group D respectively received intravenous drip of 15mL/kg TXA at 10 min before skin incision and after 3 h,the group E received intravenous drip of 15 mL/kg TXA at 10 min before skin incision and articular cavity use of 1 g TXA before closing the incision.Oral 10 mg rivaroxaban was given at postoperative 6-12 h when the drainage volume was less than 30 mL/h and then the conventional dose was used until postoperative 35 d.The intraoperative blood loss,postoperative drainage volume,hidden blood loss,blood transfusion rate,postoperative anticoagulation time,time of removing drainage tube,postoperative prothrombin time on postoperative 1 d,activated partial thromboplastin time,descend value of hemoglobin,and occurrence rates of postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) were observed in the group A,B,C,D and E.Results The intraoperative blood loss,postoperative drainage volume,hidden blood loss,blood transfusion rate and descend value of hemoglobin on postoperative 1 d had statistical differences among 5 groups(P＜0.05).The are significant differences between the group D and A in the intraoperative blood loss,postoperative drainage volume,hidden blood loss,blood transfusion rate,descend value of hemoglobin on postoperative 1 d,postoperative anticoagulation time and removal drainage tube time(P＜0.05).All cases had no symptomatic DVT and PE during the perioperative period and postoperative 3-month outpatient or telephone follow-up.Conclusion Sequential rivaroxaban use after applying TXA during THA perioperative period is safe and effective.Moreover intravenous drip of 15 mL/kg TXA at 10 min before skin incision and after 3 h has most significant effect in reducing bleeding volume during THA perioperative period.

Objective To quantifying the urine human cytomegalovirus(HCMV)DNA from the HCMV infection infants and its corresponding liver function indications,and investigate the relationship between their concentrations.Methods The u-rine samples were collected from HCMV infection infants.HCMV DNA was measured by fluorescence quantitative polymer-ase chain reaction (FQ-PCR).Serum ALT,AST,ALP,GGT,T-Bil and D-Bil liver function indications were detected and the positive rate was analyzed,simultaneously.The correlation between the logarithm urine HCMV DNA (log HCMV DNA) concentration and ALT,AST,ALP,GGT,T-Bil and D-Bil were analyzed by Spearman correlation analysis.Results The dis-tribution range ofurine log HCMV DNA in 444 HCMV infection infants was <2.70~7.90;the positive rate of serum ALT, AST,ALP,GGT,T-Bil and D-Bil were 24.8%,59.0%,95.7%,31.1%,16.7% and 16.3%,respectively.The urine log HC-MV DNA was associated with GGT and the correlation coefficient was 0.099 (P < 0.05),but no associated with ALT, AST,ALP,T-Bil and D-Bil.Conclusion The positive rate of liver function indications will rise in HCMV infection infants, the urine log HCMV DNA was associated with GGT,but not associated with other liver function indications.

Objective Stem cell transplantation is a new approach to the treatment of lower limb ischemia ( LLI) .This study was to investigate the therapeutic effect of the transplantation of autologous bone marrow mesenchymal stem cells ( BM-MSCs) in the treatment of LLI. Methods We established the left LLI model in 12 New Zealand rabbits and divided them into a control and a trial group of equal number.The control animals were injected with DMEM, while the rabbits in the trial group with autologous BM-MSCs, into the ischemic skeletal muscle.Four weeks after injection, we performed CT angiography and perfusion imaging of both lower limbs of the rabbits and conducted HE staining of the paraffin sections of the skeletal muscle of the ischemic limbs. Results Dynamic ob-servation revealed different degrees of ecderon necrosis in 2 of the LLI models in the control group, even with toenail coloboma, but no necrosis in the trial group except for some slight muscular atrophy. Both collateral arteries and blood perfusion were obviously increased in the ischemic lower limbs in the trial than in the control group.HE stai-ning showed a significantly higher density and percentage of capillaries in the skeletal muscle fibers in the former than in the latter ([6.500 ± 1.049]/HP vs [3.670 ±0.816]/HP, [9.68 ±0.56]%vs [5.87 ± 0.86]%, P<0.01), with no necrosis in either group, nor hematoma, bony tissue, or fibroid tumor in the trial group. Conclusion Autologous transplantation of BM-MSCs can improve neovascularization in ischemic lower limbs in rabbits and can be used as a safe and effective treatment of limb ischemia.

ObjectiveTo investigate the changes of high resolution computerized tomography (HRCT) of chest and quality of life and the main correlated factors of HRCT for interstitial lung disease(ILD) in patients with rheumatoid arthritis(RA).MethodsTwenty-six initial treatment patients with RA-ILD were enrolled.The following parameters were noted at baseline,12 and24 weeks for each patient:clinical features,HRCT,quality of life.ANOVA was used for repeated measurement data and stepwise multiple regression analysis were used to analyze the relativity between HRCT and other parameters.ResultsTwentysix patients were included.Twelve male(46％) patients were followed up for 24 weeks and pulmonary infection occurred in 11 patients,so the frequency rate was 42％.After being treated with prednisone and cyclophosphamide for 24 weeks,the HRCT scores were lower than before [(8+6) vs(12±5),respectively] and 16 patients' condition were improved,6 were in stable and 4 had deteriorated disease.For quality of life,the impact scores,symptom scores,activity scores,and total scores of St.George's respiratory questionnaire (SGRQ) were significantly decreased(F=3.783,6.362,4.217,4.426,P＜0.05) and all domains of the short form-36 health survey questionnaire(SF-36) had significant improvement after treatment.Stepwise multiple regression analysis showed that the impact scores(P=0.000) and symptom scores(P=0.001) of SGRQ,vitality (P=0.012) of questionnaire,globulin (P=0.027) in prior treatment and symptom scores (P--0.001 ) of SGRQ,course of disease (P=0.002),MRC score (P=0.011),vitality (P=0.036) of SF-36 questionnaire in post-treatment were the main correlated factors with HRCT features.ConclusionMale RA patients are prone to develop ILD and RA-ILD is susceptible to pulmonary infection.After early treatment,HRCT and quality of life in most patients can be improved.Respiratory symptoms,severity of dyspnea,globulin level,course of disease and vitality of patients are significantly correlated with HRCT.